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• 0 <br /> E V E R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 3830 COLBY AVE Permit#: PW2103-042 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: INSTALL UTILITIES WHILE THE CITY HAS COLBY AVE EXPOSED <br /> PW Reviewer to select all that apply below: <br /> Utility Permits (Note:Permit Technicians to Create Utility Permit for Sewer, Water, Fire, and Irrigation, as selected below) <br /> SANITARY SEWER: DOMESTIC WATER SERVICE: (Attach Calculation&Cost Est.) <br /> ❑New Connection to main plus connections to building .0 New Connection, Size -I:(Per Cost Estimate <br /> 0 Alteration M9d Omit , Or 91/4)et. Mill 0 Meter Only, Size -d Per Cost Estimate <br /> ❑ Repair ❑,Water System Dev: opment Fee Total:$ <br /> ❑ Cap-off, quantity 0 Sewer System D'velopment Fee Total: $ <br /> ❑ Reconnection stub 0 Water Servic- ine(behind meter), Size <br /> ❑ Backwater V ve Backflow Pr- ention (Outside Building): 0 RPBA or 0 DCVA <br /> NOT REQ RED NOT RE,4IRED ill MMto Ett7 �,loN GAMED, Fo Fygyt <br /> Explanation/ tility Permit#: x lanatio Utility Permit#: 9ASE ON L . <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate/Request for Reference) <br /> ❑ New Connection, Size 0 New Conne ion, Size -0 Per Cost Estimate <br /> ❑ Meter Only, Size 0 3/4" Detec eter Only, Service Size <br /> ❑Water Syst m Development Fee Total:$ g,Backfl Prevention (Outside Building): 0 DCDA <br /> ❑ Backflow revention (Outside Building): 0 DCVA NOT EQUIRED <br /> NOT QUIRED Explanation/Utility Permit#: <br /> E a on/Utility Permit#: <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-(/f yes, PWReviewerto send cost estimate request to Water Department) <br /> IkYes, Quantity 11, , See attached for reference. SEPT 10 Ttnn 59oONER• <br /> ❑ NOT REQUIRE <br /> \Plumbing ermits (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside b •ding only) <br /> ❑ Backflow revention (Inside Building): 0 DCVA(for Domestic service) 0 RPBA(for Domestic service) 0 DCDA(for Fire service) <br /> `KNOT RE UIRED <br /> Building Permits (Note:Permit Technicians to add all items selected below to associated Building Permit) <br /> STORMWATER SYSTEM DEVELOPMENT FEES: TRAFFIC M IGATION FEES: <br /> ❑YES, 0 See Attached for calculations/credit 0 YES,T ffic Mitigation Total:$ <br /> To be added on PW To be added on ❑ e Attached for calculations/credit <br /> Quantity charged SF Quantity charged SF XN REQUIRED <br /> QTY is 0 Groun only 0 all hard surfaces QTY is 0 Roof only 0 all hard surfaces <br /> $ $ <br /> :,NOT REQUI D <br /> Additional Checklists: <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> ❑YES—TYPE: 0 SFR 0 DUPLEX 0 ADU ❑ INFILL DWELLING 0 MULTI-FAMILY 0 COMMERCIAL <br /> O See Attached Letter,2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> ❑ Digit copy attached to permit record, Permit# <br /> ❑Sa ed to Address Folder in Development Tech File <br /> KNOT RE IRED <br /> FIRE_SPRINKL RS REQUIRED? <br /> ❑YES—Type <br /> KNOT RE IRED <br /> Reason: <br /> PVBLIC WORKS PERMIT REQUIRED? <br /> YES, Pe it#PW 2103 04 2 <br /> Stormwater NPDES Tab Completed in TRAKiT 14ADA Tab Completed in TRAKiT ❑ Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed By: Mk Date: ai(i I <br /> Worksheet Checked By: Date: <br /> REVISED 11/27/2019 <br /> a <br />